108 Chapter 5 At time-point T1 for the AN-patients, monopolar DBS at the middle two contacts was switched on, with a pulse width of 90μsa and a frequency of 130ms, at a mean voltage of 3.0V (2.5–3.5V). The mean voltages at T2, T3 and T4 were 3.8V (3.0–5.0V), 3.8V (3.0–4.5V) and 3.8V (2.7–4.8V) respectively. Adjustment of the stimulation intensity occurred in steps of 0.5V, with later fine-tuning in steps of 0.1V. Pulse width and frequency remained unchanged during the study. We previously published the primary outcomes of this study(1). In our findings, we observed a significant increase in BMI at the end of the follow-up period (5.32 kg/m2; +42.8%; P=.017). This increase in BMI was primarily seen in two out of the four patients (subject 2 and subject 3) (see figure 2). Additionally, we found significant decreases in psychiatric symptom questionnaire scores, which measured eating disorder symptoms, depression and anxiety. During the intraoperative period, no adverse events were observed. However, we recorded 28 severe adverse events (SAEs), with two being probably related((hypo)manic symptoms) and nine being possibly related (self-destructive behavior)to the intervention. It is worth noting that most of the SAEs were related to the (somatic) severity of AN rather than DBS (n=11). Figure 2. Time course of DBS-induced BMI (fixed effects ± SE). Linear mixed model analyses showed a significant linear effect of time on BMI (43.16±15.96, CI 95% 9.07-77.25, t=2.704, P=.017). This figure was originally published in Oudijn MS et al. Deep brain stimulation of the ventral anterior limb of the capsula interna in patients with treatment-refractory anorexia nervosa. Brain Stimul. 2021;14(6):1528-30
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